Protein Utilization in Chronic Renal Insufficiency in Children

  • Warren E. Grupe
  • Nancy S. Spinozzi
  • William E. Harmon


It is obvious that at least some of the toxic compounds responsible for uremia are metabolic products of protein catabolism. There is also ample evidence that protein metabolism is significantly altered in children with chronic renal insufficiency (Delaporte et al., 1976, 1978; Conley et al., 1980; Holliday et al., 1970; Grupe, 1981b). These studies, coupled with the empiric demonstration that low-protein diets alleviate many of the symptoms of uremia, have led to a precept that has now become axiomatic: stipulating low-protein intake in chronic renal insufficiency. There is, however, the rational goal of reducing the main dietary sources of hydrogen ion, phosphate, potassium, and sulfate to the lowest possible level commensurate with the patient’s renal function.


Energy Intake Protein Intake Essential Amino Acid Nitrogen Balance Chronic Renal Insufficiency 
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  1. Abitbol, C. L., and Holliday, M. A., 1976, Total parenteral nutrition in anuric children, Clin. Nephrol 5:153–158.PubMedGoogle Scholar
  2. Abitbol, C. L., and Holliday, M. A., 1978, Effect of energy and nitrogen intake upon urea production in children with uremia and undernutrition, Clin. Nephrol. 10:9–15.PubMedGoogle Scholar
  3. Alvestrand, A., Bergström, J., Fürst, P., Germais, G., and Widstam, U., 1978, Effect of essential amino acid supplementation on muscle and plasma free amino acids in chronic uremia, Kidney Int. 14:323–329.PubMedCrossRefGoogle Scholar
  4. Arnold, W. C., and Holliday, M. A., 1980, In vitro suppression of insulin-mediated amino acid uptake in uremic skeletal muscle, Am. J. Clin. Nutr. 33:1428–1432.PubMedGoogle Scholar
  5. Betts, P. R., and Magrath, G., 1974, Growth pattern and dietary intake of children with chronic renal insufficiency, Br. Med. J. 2:189–193.PubMedCrossRefGoogle Scholar
  6. Betts, P. R., Magrath, G., and White, R. H. R., 1977, Role of dietary energy supplementation in growth of children with chronic renal insufficiency, Br. Med. J. 1:416–418.PubMedCrossRefGoogle Scholar
  7. Broyer, M., 1974, Chronic renal failure, in: Pediatric Nephrology (P. Royer, R. Habib, H. Mathieu, M. Broyer, and A. Walsh, eds.), pp. 358–394, Saunders, Philadelphia.Google Scholar
  8. Broyer, M., Jean, G., Dartois, A., and Kleinknecht, C., 1980, Plasma and muscle free amino acids in children at the early stages of renal failure, Am. J. Clin. Nutr. 33:1396–1401.PubMedGoogle Scholar
  9. Calloway, D. H., 1975, Nitrogen balance of men with marginal intakes of protein and energy, J. Nutr. 105:914–923.PubMedGoogle Scholar
  10. Chantier, C., ElBishti, M., and Counahan, R., 1980, Nutritional therapy in children with chronic renal failure, Am. J. Clin. Nutr. 33:1682–1689.Google Scholar
  11. Conley, S. B., Rose, G. M., Robson, A. M., and Bier, D. M., 1980, Effects of dietary intake and hemodialysis on protein turnover in uremic children, Kidney Int. 17:837–846.PubMedCrossRefGoogle Scholar
  12. Counahan, R., ElBishti, M., Cox, B. D., Ogg, C. S., and Chantier, C., 1976, Plasma amino acids in children and adolescents on hemodialysis, Kidney Int. 10:471–477.PubMedCrossRefGoogle Scholar
  13. Counahan, R., ElBishti, M., and Chantier, C., 1978, Oral essential amino acids in children on regular hemodialysis, Clin. Nephrol. 9:11–14.PubMedGoogle Scholar
  14. Delaporte, C., Bergstrom, J., and Broyer, M., 1976, Variations in muscle cell protein of severely uremic children, Kidney Int. 10:239–245.PubMedCrossRefGoogle Scholar
  15. Delaporte, C., Geneviève, J., and Broyer, M., 1978, Free plasma and muscle amino acids in uremic children, Am. J. Clin. Nutr. 31:1647–1651.PubMedGoogle Scholar
  16. Elwyn, D. H., Gump, F. E., Munro, H. N., Iles, M., and Kinney, J. M., 1979, Changes in nitrogen balance of depleted patients with increasing infusions of glucose, Am. J. Clin. Nutr. 32:1597–1611.PubMedGoogle Scholar
  17. Flückiger, R., Harmon, W., Meier, W., Loo, S., and Gabbay, K. H., 1981, Hemoglobin carbamylation in uremia, N. Engl. J. Med. 304:823–827.PubMedCrossRefGoogle Scholar
  18. Garber, A. J., 1978, Skeletal muscle protein and amino acid metabolism in experimental uremia in the rat. Accelerated alanine and glutamine formation and release, J. Clin. Invest. 62:623–632.PubMedCrossRefGoogle Scholar
  19. Garza, C., Scrimshaw, N. S., and Young, V. R., 1976, Human protein requirements: The effect of variations in energy intake within the maintenance range, Am. J. Clin. Nutr. 29:280–287.PubMedGoogle Scholar
  20. Garza, C., Scrimshaw, N. S., and Young, V. R., 1977, Human protein requirements: Evaluation of the 1973 FAO/WHO safe level of protein intake for young men at high energy intakes, Br. J. Nutr. 37:403–420.PubMedCrossRefGoogle Scholar
  21. Giordano, C., 1980, Amino acids and ketoacids—advantages and pitfalls, Am. J. Clin. Nutr. 33:1649–1653.PubMedGoogle Scholar
  22. Giordano, C., DePascale, C., DeSanto, N. G., Esposito, R., Cirillo, D., and Standherlin, P., 1970, Disorder in the metabolism of some amino acids in uremia, in: Proceedings of the IVth International Congress of Nephrology, pp. 296–302, Karger, Basel.Google Scholar
  23. Giordano, C., DeSanto, N. G., DiToro, R., Pluvio, M., and Perrone, L., 1978, The imbalance effect of amino acid and keto acid diet for growth of the uremic infant, in: Proceedings of the VIIth International Congress of Nephrology, pp. 477–482, Karger, Basel.Google Scholar
  24. Grupe, W. E., 1981a, Nutritional considerations in the prognosis and treatment of children with renal disease, in: Textbook of Pediatric Nutrition (R. A. Suskind, ed.), pp. 527–536, Raven Press, New York.Google Scholar
  25. Grupe, W. E., 1981b, Perinatal nutrition related to renal function, in: Gastroenterology and Nutrition in Infancy (E. Lebenthal, ed.), pp. 837–852, Raven Press, New York.Google Scholar
  26. Harmon, W. E., Spinozzi, N. S., Sargent, J. R., and Grupe, W. E., 1979, Determination of protein catabolic rate (PCR) in children on hemodialysis by urea kinetic modeling, Pediatr. Res. 13:513.Google Scholar
  27. Harmon, W. E., Spinozzi, N. S., Meyer, A., and Grupe, W. E., 1981, The use of protein catabolic rate to monitor pediatric hemodialysis, Dial. Transpl. 10:324–330.Google Scholar
  28. Hegsted, D. M., 1978, Assessment of nitrogen requirements, Am. J. Clin. Nutr. 31:1669–1677.PubMedGoogle Scholar
  29. Holliday, M. A., and Chantier, C., 1978, Metabolic and nutritional factors in children with renal insufficiency, Kidney Int. 14:306–312.PubMedCrossRefGoogle Scholar
  30. Holliday, M. A., Chantier, C., MacDonnell, R., and Keitges, J., 1977, Effect of uremia on nutritionally induced variations in protein metabolism, Kidney Int. 11:236–245.PubMedCrossRefGoogle Scholar
  31. Holliday, M. A., Wassner, S., and Ramirez, J., 1978, Intravenous nutrition in uremic children with protein-energy malnutrition, Am. J. Clin. Nutr. 31:1854–1860.PubMedGoogle Scholar
  32. Inoue, G., Fugita, Y., Kishi, K., Yamamoto, S., and Niiyama, Y., 1974. Nutritive value of egg protein and wheat gluten in young men, Nutr. Rep. Intern. 10:201–207.Google Scholar
  33. Jones, R. W. A., Dalton, N., Start, K., ElBishti, M. M., and Chantier, C., 1980, Oral essential amino acid supplements in children with advanced chronic renal failure, Am. J. Clin. Nutr. 33:1696–1702.PubMedGoogle Scholar
  34. Keys, A. J., Andersen, J. T., and Brozek, J., 1955, Weight gain from simple overeating. I. Character of tissue gained, Metabolism 4:427–432.PubMedGoogle Scholar
  35. Kopple, J. D., 1978, Abnormal amino acid and protein metabolism in uremia, Kidney Int. 14:340–348PubMedCrossRefGoogle Scholar
  36. Motil, K. J., Harmon, W. E., and Grupe, W. E., 1980, Complications of essential amino acid hyperalimentation in children with acute renal failure, J. Parent. Enteral. Nutr. 4:32–35.CrossRefGoogle Scholar
  37. Munro, H. N., 1964, General aspects of the regulation of protein metabolism by diet and by hormones, in: Mammalian Protein Metabolism (H. N. Munro and J. B. Allison, eds.), pp. 381–481, Academic Press, New York.Google Scholar
  38. Munro, H. N., 1978, Energy and protein intakes as determinants of nitrogen balance, Kidney Int. 14:313–316.PubMedCrossRefGoogle Scholar
  39. Olson, R. E., 1975, The effect of variations in protein and calorie intake upon rate of recovery and selected physiologic response in Thai children with PCM, in: Protein—Calorie Malnutrition (R. E. Olson, ed.), p. 275, Academic Press, New York.Google Scholar
  40. Sargent, J., Gotch, F., Borah, M., Piercy, L., Spinozzi, N., Schoenfeld, P., and Humphreys, M., 1978, Urea kinetics: A guide to nutritional management of renal failure, Am. J. Clin. Nutr. 31:1696–1702.PubMedGoogle Scholar
  41. Spinozzi, N. S., and Grupe, W. E., 1977, Nutritional implications of renal disease, J. Am. Diet. Assoc. 70:493–497.PubMedGoogle Scholar
  42. Spinozzi, N. S., Murray, C. L., and Grupe, W. E., 1978, Altered taste acuity in children with end-stage renal disease (ESRD), Pediatr. Res. 12:442.CrossRefGoogle Scholar
  43. Young, G. A., and Parsons, F. M., 1973, Impairment of phenylalanine hydroxylation in chronic renal insufficiency, Clin. Sci. Mol. Med. 45:89–97.Google Scholar

Copyright information

© Plenum Publishing Corporation 1985

Authors and Affiliations

  • Warren E. Grupe
    • 1
  • Nancy S. Spinozzi
    • 1
  • William E. Harmon
    • 1
  1. 1.Division of NephrologyThe Children’s HospitalBostonUSA

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